Currently, suicide is the third leading cause of death for 15 to 24 year-olds and the sixth leading cause of death for 5 to 14 years-olds. Experts estimate that nearly 5,000 teenagers commit suicide every year and that for every suicide, there are 50 to 100 attempts. These statistics raise concerns among parents, teachers and teenagers nationwide who all want to know what they can do to prevent such a tragedy.

According to Kim Kates, Community Education and Outreach Coordinator for Samaritans of Boston (the first Samaritan branch in the United States), the teenage years are filled with a lot of decisions and teens lack the experience to realize that they will get through difficult times. In addition, society is increasingly becoming more isolated with the advent of technology, which adds to the challenge of fitting in. It is a feeling of isolation and hopelessness that Kates and others who work to prevent suicide find is the prevailing feeling among the youth who are suicidal.

When youth feel as though they have no one to turn to for help, some turn to drugs or alcohol. Others act out violently to vent their frustration. According to Douglas Jacobs, MD, Executive Director of Screening for Mental Health, which is national nonprofit organization that runs large-scale screening programs for various mental health disorders, depression among young people manifests itself in behavior problems.

Depression v. “The Blues”

Depression is common among teenagers and those who have this illness, in addition to acting out their feeling or abusing substances, are at high risk for suicide. The good news is that depression is treatable; many times, however, it goes undiagnosed. Jacobs explains that depression is different from the occasional mood swing and suicide is usually the outcome of a mental illness that has gone untreated, such as depression.

An occasional mood swing or having “the blues” is a normal reaction to life situations such as sadness or grief from the loss of a loved one. Clinical depression is a whole body illness with multiple moods, thoughts and bodily functions. “The blues” are brief, whereas depression persists. “The blues” rarely produce suicidal thoughts, but depression can result in suicide. “The blues” can be cured with a good listener and/or time to heal. Depression responds to specific medication and/or psychotherapy.

First Step in Prevention

According to Alan Berman, Ph.D., Executive Director of the American Association of Suicidology, the first order of prevention is observation. “The lay person is fully capable of recognizing when a young person is in trouble,” he said. Out of every ten people who kill themselves, eight gave clues to their intentions, according to Kates.

The following are a list of warning signs from The Samaritans of Boston.

Saying things like:“I want to kill myself”“Things will never get better.”“I’m tired of being a burden.”“No one would miss me if I were gone.”

Physical ChangesLosing or gaining weight quicklySuddenly not caring about appearance or cleanlinessUnexplained cuts, scrapes or bruises

Acting DifferentlyChanges in mood - more withdrawn, anxious, or sad, or a sudden mood lift after a down periodChanges in eating or sleeping habitsSuddenly taking more risks - not taking prescribed medication, driving drunk, ignoring physical limitations, having unprotected sex, using more drugs or alcohol

SituationsRecently losing a loved one, relationship or jobHaving money problemsHaving questions or worried about being gay, bisexual or transgender

Contagion Effect

Even understanding clues may not completely reduce the risk of suicide among teens. Unfortunately, when a community experiences a suicide there is a fear that a contagion effect may occur, which would result in a cluster of suicides. “It’s important that teenagers not identify with another suicide because they don’t know the whole story,” said Jacobs. Suicide is never the result of one incident; it is usually a combination of factors including a mental illness. If that information is not clearly explained, especially to a student body that has lost a peer, there is a risk of misinterpretation.

According to Berman, contagion occurs in five percent of suicide cases. If a celebrity commits suicide there may be a non-specific loss of hope attached to the incident. This is when a youth assumes that since this celebrity couldn’t “hack it” then what hope do they have, he said. There is also a potential for modeling through identifying with the individual that took his or her own life.

What Schools Can Do

In addition to recognizing warning signs, schools should have prevention resources available to students. Both Berman and Jacobs believe that schools should screen students for mental health, just as they do for physical health. According to Berman, 40 percent of school violence cases in the last decade involved young people who showed visible warning signs for suicide.

However, Jacobs warns that schools should talk about the problem of suicide unless it is in the context of a specific program that also offers resources to students.

A study by the Centers for Disease Control and Prevention’s National Center for Injury Prevention and Control, Youth Suicide Prevention Programs: A Resource Guide, acknowledged eight suicide prevention strategies as a framework to evaluate existing programs. These programs had two themes in common: 1. strategies to identify and refer suicidal adolescents and young adults for mental health care 2. strategies to address known or suspected risk factors for suicide among adolescents and young adults.

The following are the eight prevention strategies noted in the guide:

School gatekeeper training: This type of program is designed to help school staff identify and refer students at risk for suicide. Staff are also trained to deal with other crisis in school.

Community gatekeeper training: This type of program is designed to train community members and clinical health-care providers who see adolescents and young adult patients to identify and refer those at risk.

General suicide education: Students learn about suicide, its warning signs, and how to seek help for themselves or others. The program often incorporates a variety of activities that develop self-esteem and social competency.

Screening programs: A questionnaire or other screening instrument is used to identify high-risk adolescents and young adults and provide further assessment and treatment. Repeated assessment can be used to measure changes in attitudes or behavior over time, to test the effectiveness of a prevention strategy, and to detect potential suicidal behavior.

Peer support programs: These programs are designed to foster peer relationships and competency in social skills among high-risk adolescents and young adults.

Crisis centers and hotlines: Trained volunteers and paid staff provide telephone counseling and other services for suicidal persons. Such programs also may offer a “drop-in” crisis center and referral to mental health services.

Restriction of access to lethal means: Activities are designed to restrict access to handguns, drugs and other common means of suicide.

Intervention after suicide: These programs focus on friends and relatives of persons who have committed suicide. They are partially designed to help prevent or contain suicide clusters and to help adolescents and young adults cope effectively with the feelings of loss that follow the sudden death or suicide of a peer.

The CDC does not recommend one strategy over another, but it does recommend:

That suicide prevention programs are linked as closely as possible with professional mental health resources in the community.

Over reliance on one prevention strategy is not recommended

Incorporate promising, but underused, strategies into current programs where possible.